Incidencija epileptičnih napadaja tijekom i nakon moždanog udara u desetgodišnjem razdoblju na Neurološkoj klinici Kliničkoga centra Univerziteta u Sarajevu

Abstract

Association between epilepsy and stroke has been known since 1864. The pathophysiological basis of epileptic seizures during and after stroke is molecular changes that occur in ischemia as primary events and in hemorrhage as secondary events. The aim of the study was to determine the incidence of epileptic seizures during and after stroke, recorded over a 10-year period at the Department of Neurology, Sarajevo University Clinical Center. The study covered the period from January 1, 1989 till December 31, 1998. During the period, 7001 patients were treated at the Department. Cerebral thrombosis predominated (53.6%), whereas there were only 17.25% of patients with cerebral embolism, 21.96% with intracerebral hemorrhage, and 7.17% with subarachnoid hemorrhage. The incidence of symptomatic epileptic seizures for total patient sample according to years ranged from 0.75% to 6.67%. According to type of insult, the incidence of symptomatic epileptic seizures was 1.0%-3.37% for cerebral thrombosis, 1.22%-6.67% for cerebral embolism, 0.65%4.05% for intracerebral hemorrhage, and 1.34%-4.34% for subarachnoid hemorrhage. Associated epileptic seizures, i.e. the seizures accompanying the onset of stroke, were not included in the study. Results of the study showed that there were 75 patients with symptomtic epileptic seizures (47 with late seizures and 28 with early seizures, or 1.998% of total patient sample) during the 10-year period of observation. There were 36 cases of cerebral embolism (23 and 13 in the group of late and early seizures, respectively; 2.980%), 30 cases of intracerebral hemorrhage (23 and seven with late and early seizures, respectively; 1.951%), and seven cases of subarachnoid hemorrhage (four with late and three with early seizures; 1.394%). According to stroke types and subtypes, hemorrhagic stroke was found to be a more common etiologic factor for the occurrence of early and late symptomatic epileptic seizures, whereas cerebral embolism in ischemic stroke was a more common cause of symptomatic epileptic seizures than cerebral thrombosis. During the study period, the years 1993, 1994 and 1995 were characterized by a small number of patients with symptomatic early and late epileptic seizures (9 in total). The incidence of early and late epileptic seizures in the sample of stroke patients during the study period ranged from 1.394% to 2.980%.Veza između epilepsije i moždanog udara poznata je još od 1864. godine. Patofiziološka osnova epileptičnih napadaja tijekom i nakon moždanog udara su molekularne promjene koje u ishemiji nastaju primarno, a u hemoragiji sekundarno. Cilj ovoga rada bio je utvrditi incidenciju epileptičnih napadaja tijekom i nakon moždanog udara u desetgodišnjem razdoblju na Neurološkoj klinici Kliničkoga centra Univerziteta u Sarajevu. Obuhvaćeno je razdoblje od 1. siječnja 1989. do 31. prosinca 1998. godine, tijekom kojega je na Klinici liječen 7001 bolesnik. Najviše je bilo cerebralnih tromboza (53,65), potom cerebralnih embolija(17,25%), intracerebralnih hemoragija (21,96%) i subarahnoidnih hemoragija (7,17%). Incidencija simptomatskih epileptičnih napadaja u pojedinim godinama kretala se za ukupan uzorak od 0,75% do 6,67%. Prema tipovima inzulta incidencija je bila kako slijedi: za cerebralnu trombozu 1,0%-3,375%; za cerebralnu emboliju 1,22%-6,67%; za intracerebralnu hemoragiju 0,65%-4,05%; i za subarahnoidnu hemoragiju 1,34%-4,34%. U studiju nisu bili uključeni asocirani epileptični napadaji (napadaji kojima je započinjao moždani udar). Na temelju ispitivanja zaključeno je da je u desetgodišnjem razdoblju na Klinici bilo 75 bolesnika sa simptomatskim epileptičnim napadajima (47 bolesnika s kasnim napadajima i 28 bolesnika s ranim napadajima ili 1,998% od ukupnog uzorka naših bolesnika tijekom promatranog razdoblja). Bio je 36 bolesnika s cerebralnom embolijom (23 u skupini s kasnim napadajima i 13 u skupini s ranim napadajima; 2,980%), 30 bolesnika s intracerebralnom hemoragijom (23 u skupini s kasnim napadajima i 7 u skupini s ranim napadajima; 1,951%) i sedmoro bolesnika sa subarahnoidnim krvarenjem (4 u skupini s kasnim napadajima i 3 u skupini s ranim napadajima; 1,394%). Prema tipovima i podtipovima moždanog udara utvrđeno je daje hemoragijski moždani udar u našem kliničkom materijalu bio češći etiološki čimbenik za nastanak simptomatskih ranih i kasnih epileptičnih napadaja, dok se cerebralna embolija u ishemijskim inzultima i na našem materijalu pokazala kao češći razlog pojave simptomatskih epileptičnih napadaja u odnosu na cerebralnu trombozu. Tijekom promatranoga razdoblja mali je broj bolesnika sa simptomatskim ranim i kasnim epileptičnim napadajima (ukupno 9) zabilježen u godinama 1993., 1994. i 1995. Na temelju rezultata ovoga ispitivanja zaključeno je da se je incidencija epileptičnih napadaja u ukupnom uzorku bolesnika s moždanim udarom u desetgodišnjem razdoblju kretala od 1,394% do 2,980%